Information Collection

Ssa-454-icr

IC 189922 under ICR 200907-0960-006 · OMB 0960-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0072 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-454-BK SSA-454-ICR Form
SSA-454-ICR Cover Letter (Mock Up).pdf Instruction
SSA-454-BK Continuing Disability Review Report SSA-454-ICR-Mock-Up (F).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-454-ICR	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1589 20 CFR 416.989

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-454-BK	Continuing Disability Review Report	SSA-454-ICR-Mock-Up (F).pdf		No		Paper Only
Instruction			SSA-454-ICR Cover Letter (Mock Up).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.